LANGUAGE/SYMBOL FLUENCY

Impairments in multiple cognitive domains are predictive of MCI-to-AD progression, even among MCI patients diagnosed with single-domain amnestic MCI,. Word and symbol fluency abilities are associated with greater risk of progression to AD dementia than are isolated memory deficits. .

PROCESSING SPEED/EXECUTIVE FUNCTIONS

Attentional speed along with several dimensions of attention flexibility all add to the robust predictive capacity and reliability of the CANS-MCI Executive Function factor score.

Orientation

WORD-TO-PICTURE MATCHING

Picture Matching

FREE AND GUIDED RECALL – IMMEDIATE

The patient learns 5 sets of four different pictures by touching ones that fit into categories. The same items are displayed for free recall, shown along with two incorrect items from other categories. Incorrect answers are tested for category-guided recall and items are re-learned before a new free recall trial.

Free and Guided Recall

DESIGN MATCHING

Presents 8 designs, paired with letters in non- alphabetical order, and a set of buttons with the letters in alphabetical order. One of the designs is presented and the patient is instructed to touch its paired letter. Complexity of the required attention- switching is increased by design similarity.

Clock Hand Placement

STROOP

Stroop

NAMING

Pictures in multiple categories are shown, each with one correct, and three incorrect, 2-letter ‘word beginnings’ (e.g., Ro….. for a picture of a Rose). The patient is instructed to touch the most likely word beginning.

Naming

FREE AND GUIDED RECALL – DELAYED

Delayed Recall

TEST MEASUREMENT

To determine how close the patient’s cognitive abilities are to a sub-group with similar educational backgrounds, the patient’s abilities are measured in eight ways. These results are then compared against the distribution of test results for others having similar education.

In addition, if they have previously taken Screen’s tests, the patient’s past test results are compared to the latest results and plotted over time (longitudinally) so the earliest important cognitive changes can be detected in each of the three cognitive domains. By using longitudinal analyses with scalable test scores, even if the patient’s current test results are within the “normal” range, cognitive declines within that range can be detected—providing early warnings of active decline in high functioning patients.

Taking into account test scores, longitudinal patterns, and other background information (e.g. age, education, depression, pain medication, solvent exposure, alcohol use, head injuries, and exercise), Screen develops an overall probability that, if the patient were tested by the “gold standard” of a full neuropsychological evaluation, it would confirm the presence or absence of MCI. (Note: the “gold standard” referenced here is the full battery of neuropsychological tests that Screen measured itself against in a major study: it was administered by a completely independent neuropsychologist, took hours of face-to-face time and cost approximately $2,000).

STATISTICAL VALIDATION OF THE CANS-MCI

Screen’s test battery, the CANS-MCI, has been shown to be a scientifically valid screening tool. First, the eight cognitive testing tasks used in its test battery have proven to represent strong, independent predictors of subsequent dementia of the Alzheimer’s type(1). As reported in the Journal of Neuropsychiatry and Clinical Neurosciences, (2005), Screen’s test battery was validated through an extensive research study covering over 400 people from all economic, educational and age backgrounds in Western Washington. This study showed that the CANS-MCI was highly reliable and a valid measurement technique when compared to conclusions reached with the more laborious in-person standard measures used by neuropsychologists to detect MCI.

Then, in a separate study(2), Screen explicitly evaluated its test battery against an actual, independent, full neuropsychological exam (the “gold standard” costing $2,000 per patient report) to see if it could accurately predict the people who, when given the full neuropsychological exam, would be classified as having MCI. Although Screen’s test battery only cost a small fraction of the amount, it predicted nearly identically which people would be classified by the gold standard as having MCI or as normally functioning.

Over the last two years, the CANS-MCI has been consistently referenced by major journals in articles that covered computer-directed neuropsychological tests. In 2008, in a study that systematically reviewed the top 11 computer-based test batteries that are used to detect cognitive decline in aging populations, independent researchers gave Screen’s CANS-MCI test battery the top overall score in all categories assessed.

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